With the development and practice of Minimally Invasive Surgical (MIS) technique, has come a proliferation of medical and non-medical devices that generate video in the hospital operating room and in medical clinics. The term MIS is used to describe a number of surgeries as well as diagnostic procedures. MIS includes both laparoscopy (surgery through small holes) and endoscopy (diagnostic and therapeutic procedures performed through the body's organs and vessels). In traditional surgeries, a surgeon needs to make a large incision in order to operate. With MIS, the surgeon makes a few small holes—usually less than ½ an inch. The surgeon then inserts specially designed, thin instruments and sophisticated video equipment to perform the operation through the smaller opening. The small incisions required for MIS generate less pain, reduces hospital stays, cause less scarring and facilitate rapid recovery. A common element of MIS procedures is that a video camera and a monitor is required for the surgeon to visualize the operative field. By using video-assisted equipment, the surgeon has better visualization and magnification of internal organs and structure. Since the operative field monitor can be seen by support staff inside the operating room, awareness of the surgical procedure is improved and the staff is better able to support the surgeon. Several other sources of video have recently emerged in the operating room including cameras attached to surgical microscopes, cameras mounted inside surgical lights and pan/zoom/tilt cameras mounted to walls inside the operating room.
Integrated Operating Room (IOR) technology has been developed and visualization tools are emerging and evolving to assist medical professionals with the management of this video and equipment within the operating room. Given that current art video cameras for the operating room environment output an analog signal, that these cameras typically are used for several years, and that analog video connections such as s-video and composite are well known and understood in the art, IOR technology inside the operating room routes analog video signals exclusively with rare exception.
Outside the operating room, a need has emerged for viewing live video from cameras located inside the operating room. Physicians who are scheduled to perform a procedure in an operating room will often want to check on the readiness of the staff and the patient prior to walking into the operating room theatre. With remote viewing capability, the physician has the ability to confirm ‘first hand’ the readiness of the staff and patient. Furthermore, a peer, fellow or resident may desire or require assistance with a procedure, Again, the physician is not required to enter the operating room, or operating theater, thus reducing the need to travel to the operating room, dress in scrubs, and sometimes scrub into a procedure. Another example of this need involves intra-procedure consultation between operating rooms in which a surgeon requests a second opinion from peer surgeons located in other operating rooms within the preoperative services department. This type of consultation requires that an on-demand video conference be established between operating rooms in which both video and audio can be shared. Yet another example of this need involves real-time collaboration between pathology and the operating room in which the surgeon can show the pathologist video indicating from where a cancer biopsy was taken. The area of staff and student training is another area that benefits significantly from the ability to view high-quality live-video outside the operating room. Students and additional staff do not need to be present in the operating room, causing crowding, and potential distractions for the surgeon. Rather, they can be at a conference room location, or distributed at a variety of locations across the hospital campus.
Another example of this need is for nurse management to have visibility into operating room so that scheduling and resource management may be facilitated. An additional element of this need is that the nurse management would like to have visibility into several rooms simultaneously. The ability to remotely observe operating rooms has been shown to improve staff scheduling, room turnover and room cleaning times. Access to this type of remote visualization toolset has the potential to improve efficiency and save time for both physician and non-physician caregivers.
Consistent with the type of technology used for IOR solutions, current art systems view video outside the operating room through the use of analog video cable infrastructure. Although the video quality of analog systems is generally adequate for current art cameras, this approach has several key limitations:
The number of users served by this solution is limited, because hard-wired video signals must be brought to each ‘user’
The number of locations that can be served by this solution is equally so limited.
Wide-scale deployment of this solution is severely limited in all but new construction, due to the extensive cable infrastructure that must be installed.
Dedicated viewing hardware, analog switching equipment and displays are often required in order to complete the solution.
Distance limitations exist for video that must be addressed by expensive fiber-optic transmission equipment.
Usage and viewing of this video is extremely difficult, if not impossible to track.
The solution is not easily scalable to add more locations or more sources at a given location.
The cost of installing and maintaining the dedicated video cable infrastructure is high.
It is also important to note that the ability to remotely view a single video source of video from inside the operating room is generally inadequate. Depending on the type of operation being performed and the number of surgical modalities being employed, the remote viewer may need to see video from multiple sources such as the OR room camera, surgical light camera, microscopic camera or the endoscopic camera. Accordingly, the remote viewer requires the ability to switch remotely between the source video modalities until the proper view is selected.
As digital video compression and video streaming technologies have developed, they have become capable of offering high-quality video with low-bandwidth consumption on Ethernet data networks. This has made the technology a viable and useful alternative to the hard-wired approaches, while offering substantially more flexibility. Some examples include:
A virtually limitless number of users and locations can be simultaneously served.
Dedicated viewing stations are not required.
Viewing can be accomplished on any standard ‘Windows’ computer with the proper configuration and network connectivity.
Viewing is also possible on non Windows platforms, such as Apple MAC using open source applications.
Digital streaming video can be viewed anywhere in the hospital, on the hospital campus, or via wide area broadband connections off the hospital campus.
Smart digital video walls can be constructed and fed by embedded video decoding hardware.
Users may take advantage of the ability to remotely control certain devices, such as Pan/Zoom/Tilt (PZT) cameras.
Users may take advantage of the ability to select and view video from a multitude of devices in the operating room via remote selection capabilities.
Authorization and authentication controls, audit trails, and auto-logoff functions can be employed, to protect and track access to live content.
Content can be accessed over standard Ethernet networks, with firewall and VPN encryption capabilities.
The systems and methods described herein are unique relative to the traditional broadcast service offerings, in that this solution becomes part of the hospital's infrastructure and does not require a staff of professionals to operate. As such, it is effectively owned and operated by the staff, and does not require extensive training to use. Depending on local network policy, the system may be configured for one-to-one (unicast) or one-to-many (multicast) transmissions. Being part of the hospital operating room infrastructure, the system is always ready and available for use.
Accordingly, there is a need in the art for a system that affords surgeons and medical professionals remote access to live video generated in hospital operating rooms and clinics. Such system should offer flexibility in the format, transport medium, and viewing location of the digital video streams. The system must also offer security and auditing capabilities.